Administrators heading the state's new Quest Expanded Access program admitted the new system got off to a rocky start this month, but that the problems were to be expected and were being fixed.

"Some of this is inevitable," said Dr. Kenneth Fink, state Med-Quest division administrator, testifying yesterday at a legislative hearing. He noted problems were to be expected with launching such a large program and pointed to problems involving pharmacies, transportation, state payments and computers.

"It is short-term (problems) for a much longer-term return," he said.

The state changed the way it operates the Medicaid program for 40,000 elderly, blind and disabled residents on Feb. 1, contracting two for-profit Mainland health plans to provide managed care instead of the fee-for-service program it had offered.

The state has said it believes it can offer expanded services by having health plans manage them.

The program's start was accompanied by people confused about how it operated, problems getting some drugs and people unhappy about possibly having to change doctors. Some of the state's federally qualified health centers, or rural and urban clinics that serve the poor and elderly, have balked at signing up with the two contractors because of concerns about their business practices on the Mainland.

PROGRAMMING GLITCH

Fink and Patti Bazin, a state Department of Human Services administrator who helps oversee Quest Expanded Access, or QExA, acknowledged the state, contractors and others had received 34,750 telephone calls from people with questions or problems during the program's first three weeks.

The calls ranged from people inquiring about plans, to those worried about getting prescriptions or keeping physicians, and those questioning why they were being asked to make co-pays on drugs.

One of the bigger problems occurred at pharmacies where a programming glitch caused confusion about state payments for drugs and whether rates paid by the plans to pharmacies were at the right level.

One Neighbor Island drugstore, Maui Clinic Pharmacy, last week reported problems getting plan identification numbers for patients and that it had one person working full time to resolve issues and billing problems related to QExA.

"Everything fell through on this," Les Krenk, the pharmacy owner, said last week. "It was like the Grand Canyon. Patients were there on the bottom and we were trying to fish them out."

He and others have said the state should have rolled out the program slowly instead of switching over everyone to a new system on a single day.

'A HUGE DISCONNECT'

Bazin said there had been problems with transportation, primarily stemming from a previous loose system that in some instances reimbursed for patient cab rides to Ala Moana Center for shopping. The contractors have more rigid controls on setting up transportation.

Fink and Bazin said those and other issues are being resolved with the state employing more than two dozen people working to identify and resolve problems.

"We are making meaningful steps to take care of them and resolve them," Fink said.

But the picture painted by Fink and the state contractors, Ohana Health Plan and Evercare Quest Expanded Access, was challenged by Richard Bettini, chief executive of the Waianae Coast Comprehensive Health Center. Ohana is a unit of WellCare Health Plans of Florida and Evercare is part of UnitedHealth Group Inc.

"There's a huge disconnect here," said Bettini, explaining the change to managed care through QExA had caused upheaval for patients and center workers.

Bettini has yet to sign up to become a provider with Ohana or Evercare and had been telling patients they might have to find someone who is part of the plan networks for their healthcare needs.

REIMBURSEMENT ISSUE

Several other healthcare centers, including Waimanalo Health Center, have said they don't want to work with for-profit health plans and question whether enough specialists have signed up.

Bettini learned during the hearing that his patients won't have to go to elsewhere if he doesn't agree to become a part of Ohana or Evercare networks.

The state said Medicaid requires patient access to federally qualified health centers and as such, Waianae Comprehensive will continue to be reimbursed for services, though it may take longer than being part of Ohana's or Evercare's network.

The reimbursement issue also has been looked at by Faith Action for Community Equity, a group that has questioned whether the state should have contracted with WellCare or UnitedHealth, both of which have dealt with fraud allegations in other states. Last week, the federal government ordered WellCare to stop enrolling new customers in Medicare-backed drug and medical plans.

"We have become aware of some real issues with the parent companies of Ohana and Evercare," said the Rev. Bob Nakata, FACE president.

"That's something the committee should continue to monitor."

The state acknowledged it was aware of WellCare's Medicare issue, but that it did not affect operation of Hawai'i's Medicaid program and that it would be monitoring reimbursement practices of both Ohana and Evercare.